Long-term survival in patients with pancreatic ductal adenocarcinoma

Abstract

Background Long-term survival (LTS) is uncommon for patients with pancreatic ductal adenocarcinoma (PDAC). We sought to identify factors that predict 10-year, LTS after resection of PDAC. Methods We identified all patients with PDAC that underwent resection at UCLA after 1990, and included all patients eligible for observed LTS (1/1/1990—12/31/2004). An independent pathologist reconfirmed the diagnosis of PDAC in patients with LTS. Logistic regression was used to predict LTS based on patient and tumor characteristics. Results Of 173 included patients, 53% were male, median age at diagnosis was 66, and median survival was 23 months. The rate of observed LTS was 12.1% (n = 21). Age, sex, number of lymph nodes evaluated, margin status, lymphovascular invasion, and adjuvant chemotherapy and radiation were not associated with LTS. The following were associated with LTS on bivariate analysis: low AJCC stage (Ia, Ib, IIa) (p = 0.034), negative lymph node status (p = 0.034), low grade (well-, moderately-differentiated) (p = .001), and absence of perineural invasion (p = 0.019). Only low grade (odds ratio 7.17, p = 0.012) and absent perineural invasion (odds ratio 3.28, p = 0.036) were independently associated with increased odds of LTS. Our multivariate model demonstrated good discriminatory power for LTS, as indicated by a c-statistic of 0.7856. Conclusion Absence of perineural invasion and low tumor grade were associated with greater likelihood of LTS. Understanding the tumor biology of LTS may provide critical insight into a disease that is typically marked by aggressive behavior and limited survival.

Clinical Outcome of Exocrine Pancreatic Adenocarcinoma: A Single Center Experience

“…In contrast to that, Gong et al and Luo et al found that the presence of metastases is correlated with TTP but not OS 24,25 . A statistically significant relation between OS and TTP and adjuvant chemotherapy was documented in our study and is similar to the results of Stark et al 28 .…”

Upregulation of ZIP14 and Altered Zinc Homeostasis in Muscles in Pancreatic Cancer Cachexia

“…Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a five-year survival rate of 9.3% [1,2]. Surgical resection is currently the only curative option and is only available for localized and non-metastatic PDAC [3].…”

Computational discovery of tissue morphology biomarkers in very long-term survivors with pancreatic ductal adenocarcinoma

“…One limitation in this study is the total sample size, which includes 23 STS samples and 13 VLTS samples. This problem is faced by other similar studies, especially in the context of VLTS samples, which are rare 5,10,13 . With this sample size constraint in mind, we sought to assess the robustness of our model through rigorous cross-validation and re-parameterization.…”

“…Further, several groups have identified a subset of very long time surviving (VLTS) patients, whose median survival is more than 10 years [5][6][7][8][9][10] .…”

“…Additional work has been done to retrospectively identify clinical parameters that add prognostic value to initial diagnosis. Within these studies, few clinical features, such as perineural invasion or low AJCC grade 10 , are independently associated with VLTS patient outcomes. Other models using both categorical clinical features and continuous clinical measurements, such as BSA or CA19-9 levels, have achieved similarly poor performance in stratifying patient survival 11 .…”